Percutaneous removal of a knotted pulmonary artery catheter using a tracheostomy dilator

Abstract

This case report describes removal of a knotted, subclavian, pulmonary artery catheter using a tracheostomy dilator. With this simple method an invasive procedure might be averted.

Introduction

]. In the present case, a subclavian Swan Ganz (pulmonary artery) catheter, after formation of a knot, became firmly stuck between the clavicle and the second rib, and its subsequent method of removal is described.

Case report

).

).

Haemoblobin levels remained stable, and chest radiography showed no signs of haemothorax. Unfortunately, the patient died 9 days later because of therapy-resistant sepsis.

Discussion

].

]. In catheters inserted via the subclavian route, a potential danger is venous laceration and subsequent haemothorax.

]. Furthermore, surgical removal can be used, either by venous cut down or open surgery (ie thoracotomy).

] with a biliary stent catheter. Although there still remains a chance of venous laceration and subsequent haemothorax, we believe this procedure reduces the risk of bleeding of the subclavian vein.

The preferred technique to remove a knotted Swan Ganz catheter is to untie the knot, but in some cases this can not be achieved. In those cases, removal of a tightened knot resting behind an unflexible sheath or tracheostomy dilator with a comparable diameter could be a simple, elegant and noninvasive solution.

Figures and Tables

Chest radiography showing a knot in the pulmonary artery catheter at a position between the clavicle and the second rib.

Tracheostomy dilator and pulmonary artery catheter after removal.

Keywords

• knotting
• pulmonary artery catheter
• tracheostomy dilator